22368 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - � ---------=-- ----- ------------------ - ------ (Complete-in Duplicate) ------ This Permit Expires 1 Year From Date Issued Date Issued r________----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AVID LOCAT N_ ` L/v ----- tea x C` -. Owner's Name ------- -----•• ---------------------------------- --------------------- Ph ne _9.. f--_s�' _ _T Address__....-_ ------------------------------------------------------------------------------------------------------ - - --- ------------------------------- Contractor's Name----- i ---------- --- -------------------------- -------- ------- ----------------------------------------- Phone----•- -•-•------------------------ Installation will serve: Residence U _Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j----- Number of bedrooms - -- Number of baths.4._ Lot size l Water Supply: Public system ❑ Community system ❑ private Depth to Water Table _44ift Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes, ate___________________ ) No ❑ New Construction: Yes ET�_No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 R Septic Tank: Distance from nearest well---1._5.Q.-------Distance from foundation-,./-& ..-._..Material �-----___----------------------------- [� No, of compartments___Z-..._.--__ sV__ 7 • `` 1 -- - ---Size------ �'- 9L.9---Liquid d�pth- --.66---- - ---- Capacity----�-`ir--�-a,�`='l Disposal Field: Distance from nearest welL�.�_ _Distance from foundation---kP___..._._..Distance to nearest lot line____..__ Number of Gnes.�---- __------------------Length of each line_./Po__`.___.__________..Width of trench_ ' °'_ _____...______- - Type of filter material__7v_Cr/__�'_.........Depth of filter materiaf_�?__--__.._______Total length_---.-�00�4i�-_ Seepage Pit: Distance to nearest welt----------------------Distance from foundation--------------------Distance to nearest lot line._.__________--__ ❑ Number of pits---;--------- --------Lining material-------------------- Size:"Diameter-------- *- ----- Depth--------------------- ------ Cesspool: Distance from nearest well ----------------Distance from foundation----------------- --Lining material-------------------------------------- El Size: Diameter- (--------- ----- -------- --Depth-------------------------- -------------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well__----------------------------------___---_-------Distance from nearest building._____-____,_._____--________.___-____._. ❑ Distance fo nearest lot line-------------------- ---- ---------------=------------------ - --------------------------------------------------------------------- 1 � f Remodeling and/or repairing (describe)--- �E � �� ------ ------�I /-----/—/_0-- ----%-------------------------- ------------------------------- ------- --------------------------------- =--------------------------- --------- ----------------------------------- -----•------------------------------------------------- 1------------------------------------------ ------- --- -------------:------------------------------ ---- - - ------------------------q----------------j------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Iaw an rules and re latio of the San Joaquin Local Health District. (Signed)------------- ------------------- I--------•------------ (Owner and/or Contractor) BY: ' - --------(Title)--------- ---- '------------ - - --- --------------- - ------ (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i t , OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- --- - ------------------------ ------------------- -- DATE----- �- REVIEWED BY - -------------------------------- = '.r�`..,",.DATE:e .""' ^' --- ------------------------------- BUILDING PERMIT ISSUED. -------------------------- -------------------------------- ---------- DATE - - Alterations and/or recommendafions:l------- -------------------------- ......... -------- ------------------------------- ------------------- --------------- - ----------------- 1 ------------------------------------------ •--------I---- --------------- ------- ----------------------------- ----------------------------------------------------- ---------------------------------------•--- 1 ------ ------ --------------- . . ...... - ----- ----- .....................I---------I.............. ----------- FINAL .INSPECTION BY:. V.1=� Date_f._ _. .� 1: - _ SAN JOAQUIN LOCAL HEALTH DISTRICT ~ 7601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockfen,California Lodi, California k .Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press